A narrative review published in February’s edition of American Family Practice gave some insight on recommendations for the treatment of LBP for Family Practice physicians. The author made “key recommendations for practice” based off of a review of the literature and graded each recommendation based off of the available evidence.
A rating: consistent, good-quality, patient-oriented evidence
B rating: inconsistent or limited-quality, patient-oriented evidence
C rating: consensus, disease-oriented evidence, usual ractice, expert opinion, or case series.
A Rating Clinical Recommendations:
- Nonsteroidal anti-inflammatories, acetominophen, and muscle relaxants
- Bed rest is not helpful
- Patient education that includes advice to stay active, avoid aggravating movements and return to normal activity as soon as possible
- Physical therapy (McKenzie method and spinal stabilization) may lesson risk of recurrence
- Spinal manipulation and chiropractic technique are no more beneficial than established treatments for nonspecific low back pain
- Red flags are common in patients with acute low back pain and do not indicate serious pathology
- Without findings of serious pathology, imaging is not indicated in patients with acute low back pain
While I appreciate the effort, this article was nothing more than a narrative review with integrated expert opinion. He did say he searched PubMed for the key term: acute low back pain with multiple variations (ie. acute low back pain mckenzie), but this article only included 46 citations.
What I find interesting is that he believes spinal manipulation is no more beneficial than established treatments for nonspecific acute LBP. Doesn’t this contradict the CPR which we hold so dearly? I also find it fascinating that Physical Therapy treatments were identified as the McKenzie method and spinal stabilization. While there is clinical utility for these (and I have nothing against these), I am familiar with alot of evidence that also demonstrates effectiveness using other methods.
What do you think?
Casazza BA. Diagnosis and Treatment of Acute Low Back Pain. American Family Physician 2012; 85: 343-350.